HEALTH IS WEALTH

Panama 2018 | HEALTH & EDUCATION | REVIEW

Panama's twin public healthcare agencies combine to provide universal coverage, but rising costs and inefficiencies make figuring out the eventual centralization of the center a top priority.

Panama's healthcare system is split between a large public sector that offers a broad range of services and a smaller private sector that has seen significant growth over the past few years as citizens seek new treatment options. Health outcomes have improved steadily over the past several decades, with life expectancy and infant mortality rates now better than regional averages. As the sector continues to mature, the focus will be on ensuring that the public health system is on firm financial standing, increasing access to specialized treatments, and expanding coverage so that rural areas have the same quality of care as urban centers.

According to World Bank and UNICEF data, Panama's life expectancy has risen from 65 years in 1970 to 78 years as of 2016, above the regional average of 75 years. Fertility rates remain above the rest of the region at 2.5 per woman in 2016, but infant mortality rates have been cut in half thanks to increased access to healthcare; the WHO reported that more than 94% of births are now attended by skilled healthcare personnel.

Panama's public healthcare system is carried out by two primary organizations: the Ministry of Health (MINSA) and the Social Security Fund (CSS). Founded in 1941, CSS is the larger of the two. It serves as the nation's pension system and operates a network of healthcare facilities funded through employer and employee contributions. Thanks to Panama's high employment rates, CSS covers the majority of the population. As of 2015, 75% of the population was enrolled in CSS, but this ratio has been above 80% in previous years. The Ministry of Health is the sector's regulatory body in charge of issuing licenses, coordinating insurance, and establishing policy, and also provides medical services targeted to the remainder of the population not covered by CSS. Financed through general government revenue, MINSA operates a network of more than 800 healthcare facilities, most of which are smaller regional clinics.

The split structure of the sector has contributed to near-universal healthcare coverage, but also led to significant and at times confusing overlaps. One World Bank report estimated that half of CSS beneficiaries use MINSA services thanks to agreements between the two agencies that allow patients to seek treatment at other centers. At times, this leads to considerable inefficiencies in the system, but unifying the two would be a complicated and politically fraught undertaking. The private sector only serves an estimated 6% of the population, according to 2015 World Bank figures, and most recipients pay for coverage out of pocket. While there are only four private hospitals, they have garnered recognition for the quality of care offered thanks to partnerships with international organizations. Pacifica Salud Hospital Punta Pacifica, for example, has had a relationship with leading US healthcare center Johns Hopkins Medicine since it opened in 2006, and has been ranked one of the top healthcare facilities in Latin America.

Panama's healthcare spending is among the highest in the region on a per capita basis; according to the World Bank, healthcare made up 14.6% of all government expenditures in 2014, behind only Cuba among Latin American countries. Rising MINSA expenditures have already led the government to adjust some policies, such as limiting the amount of coverage automatically available to foreigners. Even with these proactive actions, MINSA's budget doubled from 2010 to 2017. As an even larger provider, CSS's outlays have risen at an even greater rate: from 2010 to 2017 its budget increased from just over USD2 billion to just over USD5 billion. Increasing communication and coordination between the two agencies would go a long way toward improving quality of care and cutting costs, but it goes without saying that this is easier said than done. While Panama is working with international development agencies to streamline the sector, reforms have been slow.